Eyelid Edema Research Articles

Reactivation of Herpes Zoster and HHV-6 Following COVID-19 mRNA Vaccine

A case of Herpes Zoster and HHV-6 reactivation following the COVID-19 mRNA vaccine was presented. The case is unique with a severe Herpes-Zoster reaction, with eyelid edema and hair loss. In addition, there was prominent lymph node swelling as well as high HHV-6 titers at 2.11 and Varicella-Zoster V Ab IgG, more than 4,000. Initial infection of HHV-6 in grown-up is rare, but a mononucleosis-like syndrome of different severity with prolonged lymphadenopathy has been reported. Reactive lymphadenitis positive for HHV-6 have been reported with lymphadenopathy and fever. Reactivation of latent virus usually occurs in an immunocompromised host and Primary infection is not frequent in grown-ups. It is a rare cause of lymphadenitis in an immunocompetent adult.

Similarities and differences between SUNCT and SUNA: a cross-sectional, multicentre study of 76 patients in China

BackgroundShort-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT) and short-lasting unilateral neuralgiform headache attacks with cranial autonomic symptoms (SUNA) have not been evaluated sufficiently due to limited data, particularly in China.MethodsPatients with SUNCT or SUNA treated in a tertiary headache centre or seven other headache clinics of China between April 2009 and July 2022 were studied; we compared their demographics and clinical phenotypes.ResultsThe 45 patients with SUNCT and 31 patients with SUNA had mean ages at onset of 37.22 ± 14.54 years and 42.45 ± 14.72 years, respectively. The mean ages at diagnosis of SUNCT and SUNA were 41.62 ± 12.70 years and 48.68 ± 13.80 years, respectively (p = 0.024). The correct diagnosis of SUNCT or SUNA was made after an average of 2.5 (0–20.5) years or 3.0 (0–20.7) years, respectively. Both diseases had a female predominance (SUNCT: 1.14:1; SUNA: 2.10:1). The two diseases differed in the most common attack site (temporal area in SUNCT, p = 0.017; parietal area in SUNA, p = 0.002). Qualitative descriptions of the attacks included stabbing pain (44.7%), electric-shock-like pain (36.8%), shooting pain (25.0%), and slashing pain (18.4%). Lacrimation was the most common autonomic symptom in both SUNCT and SUNA patients, while eyelid oedema, ptosis, and miosis were less frequent. Triggers such as cold air and face washing were shared by the two diseases, and they were consistently ipsilateral to the attack site.ConclusionsIn contrast to Western countries, SUNCT and SUNA in China have a greater female predominance and an earlier onset. The shared core phenotype of SUNCT and SUNA, despite their partial differences, suggests that they are the same clinical entity.

Juvenile Glaucoma Related to Pineal Tumor Post Ventriculoperineal Shunt Procedure: A Case Report

Background: Glaucoma is a cause of irreversible blindness worldwide. This study aims to describe a case of juvenile open-angle glaucoma with a history of post-ventriculoperitoneal shunt perineal tumor.
 Case presentation: A 27 years old man came with complaints of blurred vision in both eyes about 2 years ago. The vision in both eyes is felt to be progressively decreasing, almost the same in both eyes. Blurred vision felt suddenly while driving 1 year ago. The patient had been diagnosed with a pineal tumor and underwent surgery to install a ventriculoperitoneal (VP) shunt for hydrocephalus indications 3 years ago. The patient also underwent radiotherapy 26 times for the treatment of the pineal tumor. Ophthalmological examination revealed 20/80 OD and OS vision; not advanced with pinhole, no eyelid edema, intraocular pressure OD 21 mmHg, OS 23 mmHg. Visual fields index on OD 85% and OS 81%. Central corneal thickness (CCT) examination showed CCT of the right eye at 541 mm and left eye at 547 mm. The results of a brain CT scan showed that there was a heterogeneous solid mass with calcification and cystic (necrotic) in the pineal region. This patient was diagnosed with juvenile glaucoma with bilateral papillary atrophy et causa pineal tumor post VP shunt. The therapy given was latanoprost 1 drop/day ODS and Cendo Lyteers 1 drop/6 hours ODS, and Thymol 0.5% 1 drop/12 hours ODS.
 Conclusion: Monitoring and evaluation of staging and clinical progression of glaucoma patients with increased intracranial pressure is a condition that needs attention. The correlation between the two is the involvement of the lamina cribrosa in the form of a translaminar pressure gradient.

Difficult-to-treat rhinosinusitis in IgG4-related disease

Introduction: IgG4-related disease is a rare, immune disease with hyper-IgG4-gamma-globulinemia and fibro-inflammatory lesions that can occur in any organ. The diagnosis is made on the basis of clinical and histopathological criteria. In otolaryngological practice, the IgG4-related disease should be taken into account in the differential diagnosis of patients with salivary or lacrimal gland enlargement, with eyelid edema and chronic rhinosinusitis. Systemic glucocorticosteroids are the first line of treatment and can be combined with other immunosuppressants or biological treatment. The prognosis is favorable, but delay in diagnosis and therapy can lead to multiple organ failure and premature death. Case study: The paper presents a case report of patient initially treated for allergic rhinitis with asthma and eyelid edema, accompanied by rhinosinusitis, and history of numerous comorbidities (Hashimotos disease, parotid tumor, idopathic hepatitis, anemia and albinism). Imaging studies confirmed enlargement of the salivary and lacrimal glands with the upper eyelids edema and rhinosinusitis. The patient was qualified for sinus surgery. Postoperative histopathological examination enabled the diagnosis of IgG4- -related disease. For the next 5 years, the patient received prednisone and azathioprine, then prednisone and methotrexate, inhaled and nasal steroids, under constant specialist care, including otolaryngologist. Eyelid oedema resolved, asthma and allergic rhinitis were well controlled. Despite treatment, sinus symptoms gradually worsened, accompanied by headaches. The mucocele of the left frontal sinus was diagnosed and qualified for sinus reoperation. In the postoperative period, despite intensive treatment, mucocele of the right frontal sinus developed. Finally, another radical surgery on the frontal sinuses was performed (Draf III). The patient also showed other signs of progression of IgG4-related disease, including a twofold increase in serum IgG4 concentration. The lack of full control of the disease, manifested by difficult to treat rhinosinusitis, became the basis for qualification of the patient, now 44 years old, to biological treatment with rituximab.

Retrobulbar Amphotericin B Injection in Curbing the Progression of COVID Associated Rhino-orbital Cerebral Mucormycosis: A Retrospective Case Series.

Purpose To assess whether transcutaneous retrobulbar Amphotericin B (TRAMB) injection can halt disease progression and reduce the requirement of exenteration in post-COVID 19 Rhino-orbital cerebral Mucormycosis (ROCM)) with limited orbital disease. Methods Retrospective series from a single center included 22 patients with KOH proved post-COVID 19 ROCM with radiographic evidence of limited orbital involvement were evaluated from May 2021 to October 2021. TRAMB was given along with systemic intravenous Amphotericin B injection and sinus debridement. Demographic profile, clinical data, operative notes, blood and radiological investigations were evaluated. The primary outcome was to assess the halt in the progression of orbital disease. The primary outcome measure was to assess the halt of the disease progression and the secondary outcome was improvement in the clinical signs and symptoms. Results The mean age was 50.36 ± 9.72 years and 77.3% were men. The Stagewise distribution was twelve (54.5%) patients in stage 3a, four (18.2%) patients in stage 3b, four (18.2%) in stage 3c, one (4.5%) patient in stage 3d and one (4.5%) had stage 4 disease. Improvement in lid edema and conjunctival chemosis were noticed and it was statistically significant (p value < 0.01), similarly visual acuity and ocular motility showed significant improvements (p value 0.04 and < 0.01 respectively). 1 patient died and 1 patient required exenteration later. Twenty patients showed halting of orbital disease after TRAMB injection. Conclusion TRAMB can be an alternative adjuvant therapeutic option to preserve the globe in patients with limited orbital disease but not at all replacement for exenteration.

Cranial autonomic symptoms and response to monoclonal antibodies targeting the Calcitonin gene-related peptide pathway: A real-world study.

ObjectiveCranial autonomic symptoms (CAS), including conjunctival injection, tearing, nasal congestion or rhinorrhea, eyelid edema, miosis or ptosis, and forehead or facial sweating ipsilateral to headache, are often reported by patients with migraine during headache attacks. CAS is a consequence of the activation of the trigeminovascular system, which is the target of monoclonal antibodies acting on the CGRP pathway. Therefore, we hypothesized that patients with CAS might have higher trigeminovascular activation than those without CAS leading to a better response to anti-CGRP treatments.MethodsWe performed a prospective analysis including patients with episodic or chronic migraine treated with anti-CGRP monoclonal antibodies (i.e., erenumab, fremanezumab, and galcanezumab) between 2019 and 2021. The observation period included a 12-week baseline before treatment with anti-CGRP antibodies and a 12-week treatment follow-up. We evaluated the prevalence of CAS in our cohort and compared disease characteristics and treatment response (i.e., 12-week monthly headache days and 0–29, 30–49, 50–74, 75–99, and 100% monthly headache days reduction from baseline) among patients with and without CAS using the χ2 test, Kruskal–Wallis test, and Mann–Whitney U-test.ResultsOut of 136 patients, 88 (65%) had CAS. Both patients with and without CAS reported a significant decrease in monthly headache days from baseline. During the 12-week follow-up, the median difference in monthly headache days from baseline was higher in patients with CAS (-10, IQR−15 to−6) than in those without CAS (6, IQR 12 to 3; P = 0.009). However, the proportions of patients with 0 to 29, 30 to 49, 50 to 74, 75 to 99, and 100% response rates did not differ between the two groups.ConclusionsIn our cohort, the presence of CAS was associated with a greater response to monoclonal antibodies targeting the CGRP pathway. CAS could be a clinical marker of trigeminovascular activation and thus be related to a better response to CGRP treatments.

Meibomian Gland Dysfunction: A Route of Ocular Graft-Versus-Host Disease Progression That Drives a Vicious Cycle of Ocular Surface Inflammatory Damage

To investigate the role of aggressive meibomian gland dysfunction (MGD) in the immune pathogenesis of ocular graft-vs-host disease (GVHD). In mice, an allogeneic GVHD model was established by transferring bone marrow (BM) and purified splenic T cells from C57BL/6J mice into irradiated C3-SW.H2b mice (BM+T). Control groups received BM only. Mice were scored clinically across the post-transplantation period. MGD severity was categorized using the degree of atrophy on harvested lids. Immune disease was analyzed using flow cytometry of tissues along with fluorescent tracking of BM cells onto the ocular surface. In humans, parameters from 57 patients with ocular GVHD presenting to the Duke Eye Center were retrospectively reviewed. MGD was categorized using the degree of atrophy on meibographs. Immune analysis was done using high-parameter flow cytometry on tear samples. Compared with BM only, BM+T mice had higher systemic disease scores that correlated with tear fluid loss and eyelid edema. BM+T had higher immune cell infiltration in the ocular tissues and higher CD4+-cell cytokine expression in draining lymph nodes. BM+T mice with worse MGD scores had significantly worse corneal staining. In patients with ocular GVHD, 96% had other organs affected. Patients with ocular GVHD had abnormal parameters on dry eye testing, high matrix metalloproteinase-9 positivity (92%), and abundance of immune cells in tear samples. Ocular surface disease signs were worse in patients with higher MGD severity scores. Ocular GVHD is driven by a systemic, T-cell-dependent process that causes meibomian gland damage and induces a robust form of ocular surface disease that correlates with MGD severity. NOTE: Publication of this article is sponsored by the American Ophthalmological Society.

Clinical profile and demographic distribution of ophthalmia nodosa: An electronic medical record-driven big data analytics from a multitier eye care network.

To describe the demographics and clinical profile of ophthalmia nodosa in patients presenting to a multitier ophthalmology hospital network in India. This cross-sectional, hospital-based study included 3,082,727 new patients presenting between August 2010 and December 2021. Patients with a clinical diagnosis of ophthalmia nodosa in at least one eye were included as cases. The data were collected using an electronic medical record system. Overall, 434 (0.014%) patients were diagnosed with ophthalmia nodosa. Most of the patients were male (71.43%) and had unilateral (97.7%) affliction. The most common age group at presentation was during the third decade of life with 116 (26.73%) patients. The overall prevalence was higher in patients from a higher socioeconomic status (0.015%) presenting from the urban geography (0.019%) and in professionals (0.027%). The setae were identified and removed at presentation in 287 (66.13%) patients. The most common location of the setae was conjunctiva (45.72%) followed by cornea (39.64%). Most of the eyes (355; 79.95%) had mild or no visual impairment (<20/70). The most documented ocular signs were eye lid edema (35.81%), conjunctival congestion (73.87%), and corneal abrasion (29.05%). Less than one-tenth of the eyes required a surgical intervention for removal of the setae, corneal foreign body removal was performed in 10 (2.25%) eyes and conjunctival foreign body removal in four (0.90%) eyes. Ophthalmia nodosa more commonly affects males presenting during the third decade of life and is predominantly unilateral. The setae are most commonly lodged in the conjunctiva followed by the cornea, and the majority of the eyes have mild or no visual impairment.

Sex-related differences in cluster headache: A hospital-based study in Taiwan.

To compare the clinical profiles between male and female cluster headache patients from a large cohort. This hospital-based study enrolled patients diagnosed with cluster headache between 1997 to 2021. Participants completed structured questionnaires collecting information on demographics, clinical profiles, and quality of life. Treatment regimens and effectiveness were determined through medical chart review. All variables were compared between the sexes. In total, 798 patients (M/F:659/139) were enrolled. The male-to-female ratio was 4.7:1 for the full study period, but it declined from 5.2:1 to 4.3:1 for patients enrolled before and after 2010, respectively. The frequencies of chronic cluster headache (M:1.2%, F:1.4%) and aura (M:0.3%, F:0.7%) were low but similar between the sexes. Most headache features showed no difference between men and women. Female patients had significantly longer attack duration, shorter inter-bout duration, higher frequencies for eyelid edema, nausea and vomiting and lower frequencies for conjunctival injection and pacing. Sex difference did not influence headache-associated disability, anxiety, or depression, but poor sleep quality was significantly more common in women. Among menstruating women, 22/122 (18.0%) reported worsening headaches during menses. The effectiveness of treatment was similar between the sexes. Despite a decline of male-to-female ratio in the past two decades, most clinical profiles were similar between the sexes.

Clinical presentation of orbital mucormycosis in North –West Rajasthan: An observational study

India has witnessed severe complications after the second wave of global covid 19 pandemic. The new covid virus variant is so much lethal that it causes severe immunodepression in the covid survivors, and makes them prone to the opportunistic and rare mucormycosis infection. To see the spectrum of ocular manifestations in the patients of post Covid 19 mucormycosis.This was an observational study, carried out at tertiary care centre in North - West Rajasthan. Patients of mucormycosis during second wave of covid 19 pandemic in the month of April and May were included in the study. covid was diagnosed either by reverse transcriptase polymerase chain reaction (RTPCR) / high resolution computed tomography HRCT. Routine blood investigation, contrast enhanced magnetic resonance imaging (CEMRI) of paranasal sinuses, orbit and brain was done. Pottasium hydroxide (KOH) mount of nasal swab/biopsy was done for confirmation. Thorough ocular examination was done according to the preformed proforma. Out of 61 patients of mucormycosis, 47 patients had ocular involvement varying from common symptoms like lid edema, chemosis, proptosis to sight threatening central retinal artery occlusion (CRAO), Orbital Apex Syndrome and Panophthalmitis. A rare presentation of corneal ulcer and corneal eschar was also seen. Rhino orbital cerebral mucormycosis is a vision and life threatening opportunistic infection. A high index of clinical suspicion and early diagnosis with multi-disciplinary approach for the treatment can save the life of the patient.

Ophthalmologic Involvement in Adults with Histiocytic Disorders: Clinical Presentation and Treatment Outcomes

To evaluate the clinical presentation, treatment, and outcomes in adult patients with histiocytic disorders with ocular, orbital, optic nerve, or cavernous sinus involvement. Observational, retrospective chart review. Adult patients (age ≥ 18 years) at Mayo Clinic from January 1, 1996, to July 1, 2021, with histiocytic disorders. Inclusion criteria were (1) histiocytic disorder by biopsy and appropriate clinical phenotype; (2) available medical records; and (3) ocular, orbital, optic nerve, or cavernous sinus involvement. Retrospective chart review. Response to therapy, measured in clinical and radiographic impact. Thirty-two patients were identified: 7 with Langerhans cell histiocytosis (LCH); 15 with Erdheim-Chester disease (ECD); 1 with mixed LCH/ECD phenotype; 8 with Rosai-Dorfman disease (RDD); and 1 with mixed RDD/ECD phenotype. Ophthalmologic involvement was part of the initial presentation in 69% of patients (22/32). Eyelid edema (13/32, 41%) and proptosis (12/32, 38%) were the most frequent presentations. Isolated orbital or cavernous sinus involvement was present in 3 of 7 patients with LCH and 1 of 8 patients with RDD. Optic nerve sheath involvement was present in 2 of 7 LCH patients, 14 of 15 ECD patients, and 1 RDD/ECD patient. Diffuse (> 75%) orbital involvement was seen in 12 of 15 ECD patients and 1 of 7 LCH patients. Ocular involvement was seen in 1 of 15 ECD patients, 6 of 8 RDD patients, and 1 of 1 mixed RDD/ECD patient. The cavernous sinuses were involved in 1 of 7 LCH patients, 5 of 15 ECD patients, and both mixed phenotype patients. Visual acuity was affected in 14 patients (14/24, 58%) with a median logarithm of the minimum angle of resolution visual acuity of 0.1 (range, -0.12 to 3). BRAF V600E mutations were found in 75% (3/4) of LCH patients and 91% (10/11) of ECD patients. Patients received a variety of treatment, and response was variable across disease types. Orbital involvement was more commonly seen in LCH and ECD, whereas ocular involvement was more common in RDD. Visual acuity may be impacted from ocular involvement or compression of the optic nerve with diffuse orbital involvement.

A Case of Choroidal Folds in a Patient with Immunoglobulin G4-related Ophthalmic Disease

Purpose: To report a case of choroidal folds caused by enlargement of the extraocular muscles (EOM) and orbital fat in a patient with immunoglobulin (Ig) G4-related ophthalmic disease. A full recovery was achieved after steroid administration.Case summary: A 56-year-old male received intravenous high-dose steroids to treat IgG4-related ophthalmic disease presenting with bilateral eyelid edema, hypertrophy of all EOM, and mild exophthalmos. After 3 months, only slight improvement was observed and azathioprine was initiated. The patient exhibited only a minimal response over the next 2 months; all medications were therefore stopped. One month later, the patient presented with aggravation of the swelling (both eyelids), exophthalmos, and visual impairment of the left eye. The corrected vision was 1.0 in the right eye and 0.2 in the left eye; choroid folds were observed in the posterior pole of the left eye. Intravenous steroid (500 mg) was given once and oral steroids prescribed as maintenance therapy. After 2 weeks, the corrected visual acuity recovered to 1.0 in both eyes, the eyelid edema and exophthalmos improved and the choroidal folds resolved completely.Conclusions: Choroidal folds associated with enlargement of EOM and orbital fat tissue can cause visual impairment in patients with IgG4-related ophthalmic disease. Steroids are effective in the acute phases and prevent irreversible visual impairment.

A "Clinical Tetrad" for Easy Diagnosis of Lacrimal Canaliculitis.

To study the clinical presentation and highlight the "diagnostic clinical features" in patients having lacrimal canaliculitis (LC). A retrospective analysis of all patients diagnosed with primary and secondary LC was performed. A detailed slit-lamp examination of the conjunctiva, lacrimal punctum, canalicular region, and lacrimal sac was performed. Common and coexisting clinical features were highlighted. The posttreatment sequence of resolution of clinical features was also noted. Forty eyes of 36 patients (28 females, 77.78%) with a mean age of 59.5 years were included in the study. Thirty eyes (75%) had primary LC, whereas 10 had a secondary type. Previous misdiagnoses were noted in 34 (85%) eyes. The highlighting clinical features were medial eyelid edema (n = 40, 100%), pouting and hyperemia of lacrimal punctum (n = 36, 90%), yellowish canalicular hue (n = 35, 87.5%), and canalicular distention and expressible discharge (n = 32, 80%). None had features suggestive of nasolacrimal duct obstruction. Thirty-two eyes (80%) showed all four clinical features of LC, a tetrad. At a mean follow-up of 14.5 months, the complete resolution was noted in 36 (90%) eyes. We propose a "clinical tetrad" of 1. medial eyelid edema, 2. pouting and hyperemia of lacrimal punctum, 3. yellowish canalicular hue and, 4. canalicular distention, and expressible discharge, for the easier clinical diagnosis of LC. The authors believe that using this clinical tetrad may be helpful for the diagnosis of LC.

Ophthalmic Zoster, A Rare Pathology in a Child

Herpes zoster in children is rare and particularly the ophthalmic form, which can be responsible for serious ocular complications. We report the case of a 6-year-old female patient with herpes zoster ophthalmicus. The patient was 6 years old and hospitalised with a painful rash. The examination revealed an infectious syndrome, a painful vesicular rash, in a cluster, resting on an erythematous background located on the forehead and the root of the nose with eyelid edema. Slit lamp examination came back normal. The diagnosis of herpes zoster ophthalmicus was made on the basis of clinical findings. The course was favourable on acyclovir with no ocular complications and no post-herpetic pain.

Ophthalmic Zoster, A Rare Pathology in a Child

Herpes zoster in children is rare and particularly the ophthalmic form, which can be responsible for serious ocular complications. We report the case of a 6-year-old female patient with herpes zoster ophthalmicus. The patient was 6 years old and hospitalised with a painful rash. The examination revealed an infectious syndrome, a painful vesicular rash, in a cluster, resting on an erythematous background located on the forehead and the root of the nose with eyelid edema. Slit lamp examination came back normal. The diagnosis of herpes zoster ophthalmicus was made on the basis of clinical findings. The course was favourable on acyclovir with no ocular complications and no post-herpetic pain.

Powikłane zapalenie błony śluzowej nosa i zatok przynosowych u 4-letniego chłopca – opis przypadku

The reported case presents a 4-year-old boy hospitalized in the Paediatric Ward of the Warsaw Hospital for Children, diagnosed with acute rhinosinusitis accompanied by eyelid oedema and orbital cellulitis. Complications occurred after a relatively short period of illness. During hospital treatment a broad spectrum of antibiotics was included to improve the patient’s condition. Acute rhinosinusitis is a common childhood disease. Symptoms tend to subside following the application of symptomatic treatment conducted in an outpatient setting. A small number of cases is characterized by complications such as eyelid oedema, orbital cellulitis, orbital abscess or intracranial complications, which may prove hazardous to the health or life of a patient. Watchfulness and mindfulness of complications facilitate the diagnosis and implementation of appropriate treatment.

Lacrimal Gland Enlargement as an Extraintestinal Manifestation of Crohn Disease: A Case Report

A 29-year-old woman was referred for a 3-month history of recurrent fever, abdominal pain, and diarrhea. Abdominal computed tomography (CT) scans revealed diffuse intestinal wall thickening involving the transverse colon. When her abdominal pain recurred 1 month later, she noticed bilateral upper eyelid edema with an “S-shaped” contour. Lacrimal gland CT scans revealed enlarged lacrimal glands. Crohn disease sometimes presents with extraintestinal symptoms including ocular complications. Dacryoadenitis is rarely associated with ocular complications. Enteroscopy revealed a noncaseating granuloma in the small intestine, and Crohn disease was diagnosed. We report the characteristics of dacryoadenitis resulting from Crohn disease and review published case reports.

CLINICAL PROFILE OF PATIENTS OF PANOPHTHALMITIS PRESENTING TO THE TERTIARY HEALTH CARE CENTRE

Purpose -To study the clinical profile of patients of panophthalmitis presenting to the tertiary health care centre. Methods-This was a prospective observational study that involved25 patients with panophthalmitis complaining of blurring of vision, redness, pain, purulent discharge, photophobia and eyelid swelling. Results-There were 18 males and 7 females and the age group taken was 30 to 75 years.14 patients belonged to the age group of 30 to 45 years, out of which 10 were males and 4 were females. 7 patients belonged to age group of 46 to 60 years, out of which 5 were males and 2 were females. 4 patients belonged to the age group of 61 to 75 years, out of which 3 were males and 1 was female. Most common presentation in panophthalmitis patients is loss of vision in 88% patients followed by redness in 76% patients, pain in 72% patients, purulent discharge in 68% patients,photophobia in 55% patients and eyelid swelling in 48% patients. Majority of patients belong to low socioeconomic class. The most common cause was post traumatic followed by post operative and some endogenous infections spread through hematogenous route. Of the 25 cases of culture-positive panophthalmitis, 18 cases (75%) had bacterial growth and 7 cases (25%) had fungal growth. In post-traumaticpanophthalmitis, Gram-positive bacteria were the predominant species, followed by Gram-negative bacteria and fungi. In endogenous panophthalmitis, Gram-negative bacteria were the predominant species, followed by fungi and Gram-positive bacteria. In postsurgical panophthalmitis, all infections were bacterial. Conclusion-Panophthalmitis is a dreaded ocular disease and tends to occur more commonly in males of 30 to 45 years agegroup. Most common presentation of panophthalmitis is loss of vision followed by redness, pain, purulent discharge, photophobia and eyelid swelling and signs include eyelid edema, hypopyon, circumcilliary congestion, corneal haze and ulcer and vitreous haze. Most common cause of panophthalmitis was post traumatic with gram positive bacteria followed by endogenous causes with gram negative bacteria and post operative cases with gram positive bacteria isolated.

Evaluation of clinical efficacy and safety of Bibrocathol 2% eye ointment in the treatment of Chronic Blepharoconjunctivitis

Purpose: To assess the efficacy and safety of bibrocathol 2% eye ointment in patients with chronic blepharoconjunctivitis. Materials and methods: This was a multi-center, randomized, double-masked, placebo-controlled, parallel-group, phase III study. Patients with chronic blepharoconjunctivitis were randomized to apply either bibrocathol 2% (n = 100) or placebo (n = 100) three times a day for 14 days. The primary efficacy endpoint was the change from baseline to Day 15(+1 day) in the total score of signs summarizing the investigators’ assessment of the severity of lid oedema, lid erythema, debris, hyperemia, and pouting of Meibomian glands based on slit-lamp examination (modified Intention-to-treat (mITT) set). Safety endpoints included visual acuity, intraocular pressure, and adverse events. Investigators and patients performed an overall assessment of treatment tolerability. Results: On Day 15(+1 day) the least square (LS) mean change from baseline in the total sum score of signs was -8.62 (95% CI: -9.16; -8.08) in the bibrocathol group and -6.00 (95%CI: -6.54; -5.45) in the placebo group. The LS means the difference between treatment groups was statistically significant in favor of bibrocathol (-2.63 [95% CI: -3.36, -1.89], p &lt; 0.001). Bibrocathol was statistically significantly superior to placebo in reduction of the individual ocular signs scores and the patient’s-assessed ocular discomfort severity (p &lt; 0.001). No safety issues were observed concerning visual acuity, intraocular pressure, and the occurrence of adverse events. Conclusions: The study showed superior efficacy of two weeks of treatment with bibrocathol versus placebo in reducing signs and symptoms of chronic blepharoconjunctivitis. Treatment with bibrocathol 2% eye ointment was safe and well-tolerated.

Septic Cavernous Sinus Thrombosis Caused by Dental Infection

Purpose: We report a case of bilateral septic cavernous thrombosis caused by a dental infection.Case summary: A 58-year-old male was transferred to our hospital because of left-sided proptosis and eyelid swelling. The patient had fever and left temporal headache, which did not respond to oral and intravenous antibiotics. After experiencing a tooth injury while chewing hard food 3 months ago, the patient developed toothache and swelling around the tooth for which he did not take any treatment. The patient had left eyelid edema, ptosis, chemosis, and conjunctival congestion. The left eye movements were limited in all directions. Brain magnetic resonance imaging showed dilatation and thrombosis of the left superior ophthalmic vein and thrombosis of bilateral cavernous sinuses. The patient was treated with systemic antibiotics and anticoagulants. The blood culture showed growth of Parvimonas micra and Dialister Pneumosintes, which are common causes of dental infection.Conclusions: Septic thrombosis of the cavernous sinus and superior ophthalmic vein thrombophlebitis can occur due to the spread of dental infection. Prompt diagnosis and treatment are important for rapid resolution of symptoms and good prognosis.